APPLICATION FOR ADMISSION AS AN EU EXCHANGE STUDENT

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1 Please attach photo here APPLICATION FOR ADMISSION AS AN EU EXCHANGE STUDENT ERASMUS UNDERGRADUATE OTHER.... ERASMUS POSTGRADUATE (Please give details) Please read notes on back page before completing this form. Please use BLOCK CAPITALS only when completing this form. A. PERSONAL INFORMATION Last name:.. (Family name or surname as on passport) First name:..... Male Female Address for Correspondence: address: (Please write Telephone :.. Mobile phone:..... Date of Birth: /.../.. Nationality:... Country of Birth: Day Month Year Permanent Home Address:... (If different from Correspondence Address) Mother Tongue Second Language: B. ERASMUS CONTACT INFORMATION Home University: Full Address Coordinator in Home University: Home Coordinator address:..... Home Coordinator Telephone: Trinity College Erasmus Coordinator... Subject area code of Bilateral Agreement (e.g or 223 Modern EC Languages)... (please ask your Institutional Erasmus Coordinator if you do not know this code)

2 C. ACADEMIC RECORD Home University: Date of initial enrolment at Home University / Month Year Subjects currently being studied at Home University: List any other places of higher education previously attended (give name & dates): D. PROPOSED STUDY IN TRINITY COLLEGE 1. Tick the period(s) of study for which you wish to be admitted: ACADEMIC YEAR (Mid-September - June) MICHAELMAS TERM (1 st Semester : Mid-September - December) HILARY TERM (2 nd Semester: Mid-January - May) The Examination Period runs for 4 weeks in Trinity Term from mid-april to mid-may. Dates of study period at Trinity College: From...to..... No. of Months 2. List any particular courses which you are required to follow by your home institution in order to receive credit for your study in Trinity College (See Note 6) List any courses you may wish to follow, or please attach your Learning Agreement with this application. Please note that acceptance of your application does not necessarily guarantee acceptance into any particular courses (See Note 6)

3 E. ENGLISH LANGUAGE LEVEL Language of instruction at home university Please give an accurate assessment of your English language Oral Expression Beginner Elementary Intermediate Advanced Proficient Written Expression Comprehension Please list any internationally recognised English Language examinations taken: F. HEALTH (see note 7) 1. European Health Insurance Card Number (See Note 8) Are you suffering from any mental or physical illness which might require treatment during your period of study in Trinity College? (See Note 7) Yes No If you have answered 'Yes' to the above question, please forward with your application a statement from your medical practitioner describing your current state of health and certifying that you are fit for student life. Statements will be treated in strictest confidence. Contact person in case of emergency: Name... Phone number: ... G. CERTIFICATION BY APPLICANT I certify that the information given in this application is complete and accurate to the best of my knowledge. I agree to comply with all the rules and regulations of the university. Applicant's signature: Date:..... H. TO BE COMPLETED BY HOME ERASMUS COORDINATOR I confirm that this applicant has been nominated to attend Trinity College Dublin as an Erasmus Student Signature of Home Coordinator... Name (please print)... Date:... Stamp of home university

4 NOTES FOR COMPLETION OF APPLICATION FORM Please use BLOCK CAPITALS only when completing this form. 1. Before completing this form, consult your home university Coordinator who will have information on available courses or please see the course directory at the following web site: When your form is complete, please make two full photocopies, ensuring that a photograph is attached to each copy, and forward the copies with the original application form to: International Admissions & Study Abroad, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland Please note that the University will not accept faxed copies of applications. 2. The closing date for receipt of all applications for admission in September is 1 June. The closing date for receipt of applications for Hilary Term (commencing January) is 30 September. 3. Include three passport-size photographs, and ensure that they are attached to each copy of the application form.(see 1 above). 4. Include a transcript of your University/College grades to date. 5. Ensure that the application form has been signed by your home Institutional Erasmus Coordinator. 6. Please note that acceptance of your application does not guarantee acceptance into any particular courses. Under Section D, Part 2 do not list courses unless they are an absolute precondition for accepting a place in Trinity College. Under Section D, Part 3, please list any courses you may wish to follow. You will not, in any case, be required to make a final choice of courses until after you have registered at the university. You may also include your Learning Agreement with your application. 7. It is the University's policy to facilitate students with physical disabilities as far as possible, but you should note that not all parts of the university campus are suitable for such students. If you need further information, please write to the International Office giving details of your disability and of the Schools or Departments in which you wish to follow courses. Please see the web pages of the Student Disability Services 8. Please include the number of your European Health Insurance Card. Further details may be found at the following website: CHECKLIST: Have you Completed the application form and made two full photocopies Attach a passport-sized photograph to each copy of the application form (3 photos in total). Included a copy of your home university grades to date Signed Section G Ensured that your home Erasmus Institutional Coordinator has signed and stamped Section H Included a Medical Certificate (if required) Included the number of your European Health Insurance Card Students seeking admission with credit from other universities and colleges are subject to the regular admissions procedures of the College, and must make formal application through the Admissions Office for admission to a particular degree course. Such students may be allowed credit for part of the degree course, as may be determined by the Senior Lecturer of the College having regard to their qualifications and academic record to date, and providing that places are available on that course at the appropriate level. In giving admission to such students the Senior Lecturer, in consultation with the head(s) of department concerned, may impose tests to establish the competence of the students in the course they propose to abridge. One-year visiting students who may wish to formally transfer to Trinity College Dublin in the following year in order to complete their degree should note the following: 1. In order to apply for admission to an abridged course, they must already have successfully completed at least two years of study at a recognised college or university. 2. In addition to (1) above, a student may only be admitted to the final (Senior Sophister) year of a four-year degree course if they have successfully completed all the coursework and examinations prescribed for the third (Junior Sophister) year of that same course. 3. One-year students who satisfy (1) above and who have taken course work at Trinity College Dublin, but who have not successfully completed all elements prescribed for the third (Junior Sophister) year of the particular degree course to which they have applied, may be admitted to the second (Senior Freshman) or third (Junior Sophister) year of the course, as appropriate, and proceed normally from that point to qualify for a degree. Incoming visiting students who consider that they may subsequently wish to apply for transfer to Trinity College Dublin are advised to consult the head or visiting student co-ordinator of the relevant department(s) about their choice of courses before the commencement of the Michaelmas lecture term. International Admissions & Study Abroad, Trinity College Dublin, University of Dublin, Dublin 2, Ireland Phone: /2011 Fax: Web:

5 LETTER OF ACKNOWLEDGEMENT Applicant: If you would like to receive acknowledgement of your application, please address this letter to yourself and enclose it with your application. Your name and address: International Admissions & Study Abroad Trinity College Dublin The University of Dublin Dublin 2, Ireland Dear Student, We acknowledge receipt of your application for admission to Trinity College Dublin. We will write to you as soon as possible to let you know the outcome of your application. Many thanks International Admissions & Study Abroad

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